Anatomy & Physiology Strength vs. Coordination Can oral muscles, in particular the tongue, be changed through exercise? Overload principle: “If muscle performance [strength] is to improve, a load that exceeds the metabolic capacity of the muscle must be applied; that is, the muscle must be challenged to perform at a level greaterthan that to which it is accustomed” (Kisner & Colby, 2007, Thx Exercises: Foundations and Techniques ). Yes. Exercises can make the tongue stronger (Lazarus et al., 2003; Steele et al., 2009), but will strongerarticulators produce more accurate articulation? = ?? Don’t worry!!!SLPs are not always clear about whether they are using exercises to improve strength OR coordination – which are related, but not the same, functions. What is strength? The ability to apply or withstand force. Biting Strength = The amount of force the muscles of mastication are capable ofexerting. http://medical-dictio nary.thefre edictionary .com/strength Articulatory strength = ? How do muscles get stronger? Hypertrophy Micro-tears–release growth factorSatellite cells proliferate Migrate to muscle & enter sarcolemma Repair damage, donate nucleus, & lay down new proteins - Voila! A bigger muscle – But, is it more useful? Coordination: “The organization of control of motor units”(Carson , 2007) Positive effects from training are most likely when the specific muscle activation patterns - reinfo rced thr ough pr actice - are als o those required in the target task context. Non-Speech Oral Motor Exercises: Evidence and Discrepancies Karen E. Brown, PhD, CCC-SLP, Tamara B. Cranfill, PhD, CCC-SLP, Sue Mahanna-Boden, PhD, CCC-SLP Eastern Kentucky University Richmond, Kentucky Purpose The debate about non-speech oral motor exercises (NS-OMEs) has been a hot one in the field of speech-language pa thology. We took a two-pronged approach to the issue by r eviewingclinicians’ perceptions and beliefs about how and why NS -OMEs work, combined with a basic review of t he physiological effects of exercise as they apply to the articulators. In particular, we reviewed strength, range of motion, and coordination, as these factors are frequently i dentified as targeted o utcomes for NS- OMEs. Background Current research does not provide clinicians with definitive answers regarding the value of NSOMEs for the remediation of speech sound disorders (SSDs). “The existing research literature provides insufficient evidence to support or refute the use of nonspeech OMEs” (McCauley et al., 2009, p. 353). Lof and Watson (2008) found, in a national survey, that 85% of SLPs working with children with speech sound disorders (SSDs) use NSOMEs. NSOMEs are known by many names for the various exercises to remediate SSDs..mouth exercises, nonspeech oral motor training, tongue exercises, and oral motor treatment Exercise is the common denominator in this debate. Research has not provided clear guidance as to which, if any, exercises have clinical value. In light of this shortcoming, clinicia ns need to understand the physiologica l consequences of exercise so they can make informed decisions about NSOMEs. Clark (2003) proposed that SLPs should understand how exercise alters four physiologica l parameters: strength, endurance, power, and range ofmotion. However, many SLPs may not remember what they learned in A&P101 about cellular level changes that occur in response to exercise. What about populations with atypical muscle development or maintenance? In regard to conditions that result in reduced muscle mass (MD, cachexia, low tone, etc.): “Muscle wasting and weakness are among the most common inherited and acquired disorders . . . . There is no generally accepted treatment to improve muscle bulk and strength.” Schuelke et al., (2004) in theNew England Journal of MedicineConcluding Thoughts What can a clinician do? If you choose to use NS-OMEs: 1. Understand the physiology: Muscle strengthening –overload principle 2. What’s really needed? More strength? Recruitment of additional motor units? More strength? Recruitment of available/alternative motor units? Development of a new pattern of movement? 3. Document–Use objective measurements ofStrength Range of motion Stimulability Change over time Contact: [email protected]Is the tongue like other voluntary muscles? Yes. . . and No. § Strengthened through the process of hypertrophy. § Movements for speech (elevation, placement, & pressure) likely employ both extrinsic and intrinsic muscles (Steele et al., 2009). § Unique muscle fiber patters, ex: imbricated– like overlapping fish scales; interdigitated– intermingling (Hixon, Weismer, & Hoit (2008), produce a wide range of motion. § Muscle spindles (related to muscle tone) are not consistently found in the tongue (Cooper, 1960; Neilson, Andrews, Guitar, & Quinn, 1979; as reported in Clark, 2003). § Unique sensory-motor feedback system http://www.bio.miami.edu/~ cmallery/150/neuro/normal.muscle.jpg Evidence for NS-OMEs No peer-reviewed studies published supporting the use of NS-OMEs to remediate speech sound disorders. Only one study. . . Polmanteer, K., & Fields, D. (2002, Nov.) Effectiveness of oral motortechniques in articulation and phonology treatment. Poster session presented at the annual convention of the American Speech-Language-Hearing Association, Atlanta, GA Evidence against NS-OMEs •Lass & Pannbacker (2008) reviewed the literature on NSOMEs and concluded that “sufficient evidence does not exist for NSOMTs’ [nonspeech oral motor treatment] effectiveness in improving speech, and therefore NSOMTs should be excluded from use as a mainstream treatment” (pg. 418). Language, Speech and Hearing Services in Schools, 39, 408-421. •Colone & Forrest (2002, Nov.) Comparison oftreatment efficacy for persistent speech disorders. Poster session presented at the ASHA annual convention, Washington, D.C. •Lof & Watson (2008) A nationwide survey ofnonspeech oral motor exercise use: Implications forevidence based practice. LSHSS, 39, 392-407. •MORE AVAILABLE. . . “Neurons that fire togetherwire together.” (Hebb) Practicing erroneous muscle movement = Excellent erroneous muscle movement! Habitual reinf orce men t - TA SK SPECIFIC! McCauley, Strand, Lof, Schooling, & Frymark (2009). Evidence-based systematic review: Effects of nonspeech oral motor exercises on speech. AJSLP , 18, 343-360. Articles from 1960-2007 (4 7 years) 15 met criteria (out of 899 potential citations) Considerable variations Not enough evidence to support orrefute the use of NS-OMEs The bottom line is not clear!
